Congestive Heart Failure

Congestive heart failure (CHF) refers to an abnormal build-up of fluid within the lungs. The congestion occurs as the result of the ineffective pumping action by the heart. Severe congestive heart failure is also referred to as pulmonary edema.
 
Causes
There are numerous causes of congestive heart failure:
 

•	Valvular Heart Disease — Incompetency (leakage or blockage) of the heart valves leads to an ineffective flow of blood through the heart. Over time, the heart will attempt to compensate for the problem by “enlarging,” eventually leading to congestive heart failure, heart attack, cardiac arrhythmias, or cardiac arrest (heart stops beating). Valve replacements have improved the survival rate in these patients.
•	Cardiomyopathy — This medical term describes a weakness in the heart muscle’s ability to contract. This may result from the effects of long standing hypertension, diabetes, alcohol abuse, or multiple heart attacks, all of which can damage the heart muscle to a point that its pumping function has been compromised.
•	Viral Myocarditis — In addition to irregularities (arrhythmia) of the heart beat, this viral infection of the heart can result in poor cardiac muscle function. Viral myocarditis is one of few causes for heart failure seen in young people.
•	Severe anemia — This condition can precipitate heart failure in the patient with a very low red blood cell count. The heart will go into congestive failure as it attempts to compensate for the inadequate number of circulating red blood cells. Red blood cells are necessary for adequate oxygenation of the tissues.
•	Myocardial infarction (heart attack) — This can cause sudden (acute) congestive heart failure in cases where a substantial portion of the heart muscle has become severely damaged. The lack of oxygen to the cardiac muscle results in poor contraction.

 
Symptoms

•	Increased shortness of breath while lying flat (patient may sleep with two or more pillows)
•	Awakening in the middle of the night short of breath
•	Increasing shortness of breath upon exertion
•	A productive cough, resulting in frothy, pink tinged sputum
•	Leg swelling and/or abdominal swelling

 
Diagnosis
Evaluation will include a history and physical examination. Blood tests (blood counts, cardiac enzymes, chemistry), and a chest X-ray will be performed. The chest X-ray can show changes consistent with the diagnosis of congestive heart failure. An echocardiogram may be helpful in cases of suspected heart valve abnormalities. The ECG can reveal evidence of a potential heart attack (myocardial infarction).
 
Treatment
Treatment for the majority of patients will involve hospitalisation. Many cases necessitate a complete cardiac evaluation to exclude the possibility of a heart attack. This will require, at minimum, 24 hours of close medical observation and monitoring. Oxygen and diuretic medications are the mainstay of therapy (Lasix). Other special medications that lower the blood pressure may also be used (nitroglycerin). Medications that encourage the heart to pump blood more effectively are used in some limited cases (digoxin).
 
In most cases, the patient will breathe better when sitting upright.
 
Recurrences are common in those with a history for congestive heart failure. These patients must carefully restrict their salt (sodium) intake. A cardiologist or internist is the expert in the management of patients with congestive heart failure.
 
Prevention

•	Lower dietary sodium with the hypertension diet
•	The proper cardiac diet, low in fats and cholesterol is also recommended
•	Regular physician check-ups allow for the early detection of fluid retention (leading to CHF); follow your weight closely
•	Weight loss in those patients who suffer from obesity
•	A physician approved exercise program
•	Stop smoking
•	Control other cardiac risk factors: diabetes, hypertension, and elevated cholesterol

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